‘The most human thing you can do is to comfort’: An MSF Canada therapist on providing mental health care

Mental health care is an essential component of emergency humanitarian medical interventions. This interview with Maren Heldberg, a psychosocial worker based in Toronto who recently returned from Mosul, Iraq, shines a light on the impact MSF’s mental health activities can have on the communities where we intervene.

“Our mandate is to save lives, yes, but it’s also to alleviate suffering,” says Maren Heldberg, a psychotherapist based in Toronto who recently returned from helping Doctors Without Borders/Médecins Sans Frontières (MSF) provide mental health counselling alongside primary healthcare to people in Mosul, in northern Iraq. “If we want to alleviate suffering, then we can’t just amputate a leg after a bomb explosion and ignore the person’s psychological or psychosocial needs. We need to also somehow help this person cope with life again.”

Before Mosul, Heldberg had been part of MSF’s mental-health activities in Syria, Greece and Democratic Republic of Congo. She says that many people are still surprised to learn that MSF provides psychological as well as medical care when responding to humanitarian emergencies around the world.

“People often don’t know we actually do mental health,” she says. “I think a lot of people associate Doctors Without Borders obviously with medical doctors, but we cover a lot more than that.”

MSF hasn’t always included mental-health care in its medical humanitarian activities. When the organization first began, the focus was on emergency and primary lifesaving medical care. But in 1998, MSF formally recognized the need to implement mental health interventions even in emergency settings, in order to restore dignity to people whose lives have been uprooted by disaster. Today, many of MSF’s international medical projects include a mental health component.

MSF provides care to people who have been affected by conflict, violence or neglect, and many of those patients have been exposed to immense trauma. “Oftentimes they have never had the opportunity to actually talk about their experiences and to tell their story,” Heldberg says.

Maren Heldberg, second from right, with colleagues in Mosul, Iraq.

A city exposed to trauma

By the time Heldberg arrived in early 2018, many people in war-torn Mosul had endured extremely difficult circumstances. After the end of the Iraq War, the city came under the control of ISIS, and residents were isolated from critical care. Even today, they still lack reliable access to food and medical care.

“ISIS had left about six months before I arrived there,” Heldberg recalls. “People were forced to watch public executions. There were large amounts of airstrikes, lots of people lost one, two, three, four family members. Lots of children that were hit by airstrikes.”

Upon her arrival, Heldberg and her team carried out a mental-health assessment to help determine the community’s needs, then hired local support workers and trained them from scratch. But they had difficulty filling their clinic with patients at first, and had a lot of work to do raising awareness. “A big thing in the Middle East is stigma. People don’t want to be seen talking to a mental health professional because they think the community will think they’re crazy.” But as MSF teams continued to explain the clinic’s mental health services to members of the community, more and more people felt able to seek consultation and care.

Often, says Heldberg, there is a certain mindset for people who set out to do humanitarian work. “We often go into the field thinking that we will change the world, but the reality is the world will change you.”

She says aid workers are often confronted with feelings of helplessness in the face of overwhelming catastrophe. But the role of an MSF psychosocial caregiver is not necessarily to “cure” people of their mental health issues. She finds guidance in the 2,400-year-old wisdom of Hippocrates: “Cure sometimes, treat often, comfort always.”

Mental health care makes a difference

“In mental health you can hardly ever cure someone,” she says. “That can be quite challenging, to feel quite helpless at times because you want to help so much more. … But I try and remind myself again and again of the mandate that MSF has. In order to alleviate suffering in many cases, especially in conflict zones, the only thing, and the most human thing you can do, is to comfort.”

Despite the challenges, Heldberg finds her work ultimately does make a difference in the lives of the people MSF seeks to help.

“As mental health professionals, we listen, we comfort people, we cry with people, we try and help them process their grief and their sadness so they can somehow move on in life. But it also takes time, it takes months, years, decades; so it’s hard to summarize all of this statistically,” she says.

“And yet I think we do make a difference. Because ultimately, there is no such thing as good physical health without good mental health.”

To date, MSF teams have offered mental health care in more than 40 countries around the world. In 2017, MSF held more than 306,000 mental health consultations worldwide, and 49,800 group mental health sessions.